Neck pain, back pain, and osteoarthritis are common musculoskeletal conditions treated by pain practitioners. They rank among the leading causes of disability worldwide and are reportedly on the rise.
Neck pain, back pain, and osteoarthritis frequently occur alongside chronic conditions such as cardiovascular disease, cancer, diabetes, chronic respiratory disease, and obesity, raising the question:
To answer this question, researchers from Australia, the UK, and Denmark conducted a systematic review and meta-analysis of studies looking into potential associations between neck or back pain, osteoarthritis of the knee or hip and the most prevalent chronic diseases: cardiovascular disease, cancer, diabetes, chronic respiratory disease, and obesity (3).
The authors chose to evaluate only longitudinal cohort studies (which collect data for the same subjects repeatedly over a period of time) to specifically assess whether having one of the above musculoskeletal conditions makes a person more likely to be diagnosed with a chronic disease.
Literature search on electronic databases yielded 13 cohort studies involving a total of 3,086,612 people (most older than 50). Meta-analysis (a statistical analysis that combines the results from related studies) was performed over 10 studies where osteoarthritis (n = 8) and back pain (n = 2) were the exposure and cardiovascular disease (n = 8), cancer (n = 1) and diabetes (n = 1) were the outcomes.
Pooled results from these 10 studies (2,686,113 people) showed that the chances of developing a chronic disease are 17% greater in people with a musculoskeletal condition, compared to people without. However, because most studies (n = 7) addressed osteoarthritis as the exposure and cardiovascular disease as the outcome, the authors point out that this risk can be more specifically ascribed to this particular combination of musculoskeletal condition/chronic disease.
Although combined estimates for the risk of chronic disease in people with back or neck pain could not be obtained due to the limited number of studies assessing these conditions, individual studies offered evidence of their relationship.
These estimations were adjusted for additional risk factors like age, BMI, socioeconomic indicators, and drinking and smoking status, so the correlations found relate specifically to the conditions assessed.
There are three possible explanations for the associations shown above:
When assessing for potential explanations some distinctions can be made for neck and back pain, on the one hand, and for osteoarthritis on the other.
While no specific mechanisms linking neck and back pain to chronic disease have yet been defined, a more complicated, perhaps direct, relationship may exist between osteoarthritis and both diabetes and cardiovascular disease. Being overweight is a risk factor for both osteoarthritis and diabetes; atherosclerosis may promote osteoarthritis development; and inflammatory changes during osteoarthritis may increase the risk for cardiovascular disease (8).
To learn more about inflammatory pain and chronic disease, check out my blog, PRESCRIBING OPTIMAL NUTRITION AND PHYSICAL ACTIVITY FOR LOW-GRADE CHRONIC INFLAMMATION AND PAIN.
Chronic diseases (also called ‘lifestyle’ diseases) are largely preventable; although genetics can increase susceptibility in some people, environmental factors are mostly to blame. Chronic pain caused by musculoskeletal conditions usually restricts physical activity and leads to weight gain; it is well documented that sedentarism, malnutrition, obesity, and smoking, rather than genetic factors, are main precipitating factors of chronic disease (9, 10).
Though more research is needed, the overall results of the meta-analysis appear to be more in line with the main conclusion of one of the studies, which points to disability, rather than osteoarthritis, as the predictor of cardiovascular disease (11).
People are living longer, and both musculoskeletal pain and chronic diseases are expected to grow in tandem. Physical therapists are in a unique position to prevent and reduce the burden of chronic disease, disability, and pain by promoting physical activity and healthy nutrition patterns. To help you meet this challenge, valuable insights and resources can be found in my blogs and podcasts.
Click here to learn about the Certification in Functional Nutrition for Chronic Pain!
1- Vos, T., Allen, C., Arora, M., Barber, R. M., Bhutta, Z. A., Brown, A., … & Coggeshall, M. (2016). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet, 388(10053), 1545-1602.
3- Williams, A., Kamper, S. J., Wiggers, J. H., O’Brien, K. M., Lee, H., Wolfenden, L., Yoong, S. L., Robson, E., McAuley, J. H., Hartvigsen, J., … Williams, C. M. (2018). Musculoskeletal conditions may increase the risk of chronic disease: a systematic review and meta-analysis of cohort studies. BMC medicine, 16(1), 167. doi:10.1186/s12916-018-1151-2
4- Jordan, K. P., & Croft, P. (2010). Mortality and cancer in patients with new musculoskeletal episodes: a cohort study. The British journal of general practice : the journal of the Royal College of General Practitioners, 60(572), e105-11.
5- McBeth, J., Silman, A. J., & Macfarlane, G. J. (2003). Association of widespread body pain with an increased risk of cancer and reduced cancer survival: A prospective, population‐based study. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 48(6), 1686-1692.
6- Kendzerska, T., King, L. K., Lipscombe, L., Croxford, R., Stanaitis, I., & Hawker, G. A. (2018). The impact of hip and knee osteoarthritis on the subsequent risk of incident diabetes: a population-based cohort study. Diabetologia, 61(11), 2290-2299.
7- Rahman, M. M., Cibere, J., Anis, A. H., Goldsmith, C. H., & Kopec, J. A. (2014). Risk of type 2 diabetes among osteoarthritis patients in a prospective longitudinal study. International journal of rheumatology, 2014.
8- Sokolove, J., & Lepus, C. M. (2013). Role of inflammation in the pathogenesis of osteoarthritis: latest findings and interpretations. Therapeutic advances in musculoskeletal disease, 5(2), 77-94.
9- Booth, F. W., Roberts, C. K., & Laye, M. J. (2011). Lack of exercise is a major cause of chronic diseases. Comprehensive Physiology, 2(2), 1143-1211.
10- Bruins, M., Van Dael, P., & Eggersdorfer, M. (2019). The Role of Nutrients in Reducing the Risk for Noncommunicable Diseases during Aging. Nutrients, 11(1), 85.
11- Hoeven, T. A., Leening, M. J. G., Bindels, P. J., Castaño-Betancourt, M., van Meurs, J. B., Franco, O. H., … & Bierma-Zeinstra, S. M. (2015). Disability and not osteoarthritis predicts cardiovascular disease: a prospective population-based cohort study. Annals of the rheumatic diseases, 74(4), 752-756